Our Lady Queen of Peace Catholic Preschool

Our Lady Queen of Peace Catholic Preschool

Enrollment Form 2017-2018 – Due March 15, 2017

Child’s First, Middle, & Last Name______/ Birth Date ______Program enrolling in: / circle one / circle one
4-year-old / all day M-F
Home Phone # ______/ Family Last Name ______/ 3-year-old / all day MWF
(only if different than child) / all day Tu/Th
Primary Home Address ______/ Parishioner: Y / N / am only M-F
street # & street name / city / zip / (circle one) / am only MWF
am only Tu/Th
Family E-Mail Address ______
Father’s Name ______/ Father’s Religion ______
last name / first name
Father’s Occupation ______/ Position ______Name of Employer ______
Father’s Cell # ______/ Father’s Work # ______
Mother’s Name ______/ Mother’s Religion ______
maiden name / first name
Mother’s Occupation ______/ Position ______Name of Employer ______
Mother’s Cell # ______/ Mother’s Work # ______
Marital Status of Birth Parents ______/ (M-Married, D-Divorced, S-Separated, W-Widowed)
If divorced, status of father ______(R-Remarried, S-Single) / Step-Mother (if applicable) ______
If divorced, status of mother ______(R-Remarried, S-Single) / Step-Father (if applicable) ______
Child(ren) resides with _____ Both Parents / _____ Mother Only / _____ Father Only / _____ Other** Please explain______

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Please list the children of your family that are registering at Our Lady Queen of Peace Catholic School for the 2017-2018 school year with the appropriate information for each:

Child’s / First / Middle / Birth / Place of / Ethnic / Grade
Last Name / Name / Name / Date / Birth / Gender / Religion / Group / 2017-2018

Please list other siblings, ages, and schools they attend:

Sibling’s Name Age School

(If you have a child entering Kindergarten, please know that you must also complete a separate kindergarten registration form.)

Registration Fee: $100.00 per child (non-refundable)

REGISTRATION FEES AND UPDATED IMMUNIZATION RECORDS MUST ACCOMPANY ALL REGISTRATIONS FORMS TO SECURE 2017-2018

PLACEMENT. OTHERWISE, REGISTRATION FORMS WILL BE RETURNED.

Parent Signature ______

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For Office Use Only: Amount Due ______Amount Paid ______Date Paid ______Check # ______

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